War Hospital: A True Story of Surgery and Survival (review)

Dr. Sheri Fink has written an engrossing, detailed description of the humanitarian disaster that occurred in the former Yugoslavia in the early 1990s, when Ser-bian forces fought Muslim neighbors. Although hostilities began in 1991 in Croatia, the events in this book occurred after they had spread to Bosnia. The medical aspects of the story, which are covered in detail, are of considerable interest. The political background of the conflict is briefly but amply covered, including the underlying memories that go back over a half a millennium; for example, Serbs, after capture of the Bosnian town of Sebrenica following the prolonged siege that is central to the book, hailed their success as "liberation from the Turks."

Most of the book is a description of the experiences of individual doctors and nurses, trapped, many voluntarily, in Srebrenica, some traveling long distances through mined areas and battle zones in order to help. Civilians injured by shelling of the town with a population of about 50,000, as well as front-line soldiers, needed care in the area's only hospital. Cut off by the fighting, quickly depleted of basic medical necessities, doctors without surgical training often were forced to do what they could. Fink's descriptions of the conditions and surgical procedures resemble those of the American Civil War, although failure to provide aseptic surgical conditions was due to the lack of facilities rather than lack of knowledge. Constantly discharging infected wounds, typical of the U.S. Civil War, were common. The devastating nature of bowel injury, without anesthesia or trained surgeons, was another similarity. A great deal of the time the hospital in Srebrenica lacked any anesthetic, worse conditions than existed during the Civil War (except for some periods in Confederate hospitals). The terrible dilemma faced by the doctors, knowing that without needed surgery, primarily amputations, the patient would die (again like the American Civil War), and the plight of the suffering patients, are well described. Surgery often had to be done without electricity, using smoky light from oil lamps or makeshift candles or a flashlight. Surgeons often worked wearing flak jackets, periodically ducking into corridors to avoid injury from the shelling.

Fink conducted hundreds of interviews of participants in these disastrous events, quoting many directly or providing descriptions of their memories of conversations. Her narrative thus reads like a novel and is intensely gripping, although its authenticity and the events described make it far more interesting than a novel would be.

Doctors Without Borders (Médicins sans Frontières, MSF), of which Fink was a participant, comes through as the only agency sincerely interested and effective in providing humanitarian aid, without regard to political considerations, and often at great personal risk to safety of their personnel. Fink is critical of the International Red Cross, pointing out that the MSF was born out of the Red Cross during Civil War in Biafra in late 1960s, when the Red Cross kept silent about the genocide against the Biafrans. She quotes Camus in The Plague, describing the policies of the Red Cross as "solely valid in a world where violence against mankind comes only from eruptions, floods, crickets or rats. And not from men." The MSF, she points out, would go wherever people suffered, regardless of the cause or political or military boundaries, and she documents the differences in the policies of that organization from that of other international humanitarian agencies extensively in this book.

Fink describes the ineffectiveness of both the United Nations and NATO in enforcing a cease-fire and "safe zone" after agreements by both sides. It finally resulted in capture of the town, the exporting of the remaining male population, who were never heard from again, and a mass exodus primarily of female and under- or over-aged people, who were forced to wander through hostile, mined territory seeking sanctuary in Muslim-controlled Tuzla. The book has excellent, very helpful maps.

Bureaucratic Catch 22–type rules prevented action by...